Arthritis And Rheumatism

( Originally Published 1940 )

MORE than three million persons in this country suffer from some form of arthritis, or rheumatic disease of the joints. A considerable percentage of these are partially or completely disabled. Much of this disability and invalidism could be avoided if adequate medical and dental care were available, and if reliance were not placed on the drugs, salves, waters and balms advertised for the relief or cure of "rheumatism."

Rheumatism is not a disease. It is simply a descriptive term applied to any persistent or recurrent disorder of the musts or joints. As more knowledge of these disorders ac-cumulated, the term was discarded and replaced by more precise designations indicating the site and the character of the disease. Thus, inflammation of the muscles is known as myositis; of the connective tissue, fibrositis; and of the joints, arthritis. Because more exact definitions are now possible, the term "rheumatism" has been discarded in medical terminology.

The term was also formerly applied to attacks of neuritis, neuralgia, lumbago and sciatica. Neuritis is an inflammation or degeneration of a nerve or group of nerves. It may be caused by infection, poisons, injuries or vitamin deficiency. Neuralgia simply means pain along the pathway of a nerve, and is usually caused by a disorder of one of the internal organs. Lumbago, which is a pain in the back, may be due to any one of a number of disorders of the muscles, bones, joints or ligaments of the back; or to disease within the abdomen, such as tumors of the womb, kidney infections or disorders of the digestive tract. Sciatica means pain along the sciatic nerve, a nerve which runs down the back of the thigh. Like lumbago, it may be due to any one of a multitude of conditions. A careful history, a complete physical examination and often X-ray examinations are necessary to distinguish the various conditions from one another, and to discover the cause of each particular ailment.

Many cases of so-called "rheumatism" of the spine, hips and knees and sacroiliac region are really caused by foot disorders. In these cases, correction of the foot troubles and the wearing of proper shoes may yield complete relief.

In early adult life and in childhood an acute type of "rheumatism" may occur with involvement of the heart. This is known as acute rheumatic fever. Because of the involvement of the heart and blood vessels this is a serious affliction which requires immediate medical care. Often rheumatic fever in children begins with apparently innocent aches and pains of the muscles and joints. There may or may not be swelling of the joints. The danger of self-treatment of such pains or swellings with proprietary remedies is self-evident.

Besides those troubled by the miscellaneous ailments de-scribed above, there is a large body of disabled people (amounting to several million, it is estimated) who are suffering from true arthritis, or inflammation of one or more joints. Although the cause of arthritis is not yet known, much can be done to halt the disease. Medical science has evolved a plan of treatment that can usually produce complete recovery or definite improvement. Of primary importance is a careful examination, and occasionally X-ray studies, so that the type of arthritis can be determined. In young people and adults up to fifty, arthritis is usually of the atrophic type. This variety is also known as infectious arthrifis. In middle-aged or elderly people, arthritis is usually of the hypertrophic or degenerative type. Atrophic arthritis is sometimes caused by a focus of infection somewhere in the body. Removal of this focus may produce complete recovery.

In all varieties of arthritis, certain general hygienic measures must be undertaken. Rest, physical therapy, including baths, massage and exercise, diet and, last but very important, mental hygiene-all must be used in order to achieve the best results. For such a program the coordinated efforts of general practitioner, orthopedist, physiotherapist, dietitian, and nurses may be necessary, particularly in advanced cases, which require hospital or sanatorium care.

In the treatment of all types of arthritis, drugs are often used for the relief of pain, but no single drug or combination of drugs has ever cured true arthritis. A drug, judiciously chosen and administered, can give a great deal of comfort, but no competent physician expects it to cure the disease. Drugs improperly chosen or self-administered from the stock of hundreds that are extravagantly advertised to the public will cause postponement of needed medical care. These drugs not only will not cure arthritis, but they can cause serious harm and even death.

The most dangerous of these drugs is cinchophen or, as it is sometimes called, atophan. This drug, incorporated in many patent medicines or administered as such, has been responsible for many deaths and a far greater number of serious illnesses.

In 1932 Dr. P. S. Hench of the Mayo Clinic, one of those who drew attention to the serious reactions following the use of remedies which contain cinchophen, said: "Cinchophen is sold in so many preparations and under so many names that it is almost impossible for patients taking medicine for chronic pain to avoid it at one time or another." The following preparations were reported to contain cinchophen at the time they were tested:

The dangers in the use of cinchophen are so well recognized now that the U. S. government has at last been empowered to proceed against those cinchophen-containing preparations which are "dangerous to health when used in the dosage, or with the frequency or duration prescribed, recommended or suggested in the labeling thereof."

Other "rheumatism" remedies contain aminopyrine, acetanilid and acetphenetidin (see Pain, page 30). Causalin, a compound widely advertised for the relief of "rheumatism," contains aminopyrine and another chemical, hydroxyquinoline. Both drugs are notorious for their ability to cause
agranulocytosis. Such double-barreled assaults upon life are not uncommon in the patent-medicine industry.

Besides drugs that are taken by mouth, there are balms, poultices, salves, syrups, liniments, vitamins and mechanical appliances advertised for the relief of arthritis. Several pages would be required to list all of them by name. Fortunately, the composition of many of these drugs has been changed as a result of the new Food and Drug Law. Not a single patient with arthritis would be the worse off if all of these remedies were dumped into the ocean. Many would now be better off if that humanitarian service had been performed long ago.